Citation Nr: 21001886 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-47 195 DATE: January 12, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to service connection for diabetes mellitus is denied. REMANDED Entitlement to service connection for coronary artery disease (CAD) is remanded. Entitlement to service connection for joint pain, to include chronic demyelinating polyneuropathy, is remanded. Entitlement to service connection for gout is remanded. Entitlement to service connection for a corneal abrasion is remanded. FINDINGS OF FACT 1. There is no competent and credible evidence establishing that the Veteran currently suffers from an acquired psychiatric disorder. 2. There is no competent and credible evidence establishing that the Veteran currently suffers from diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for an acquired psychiatric disorder have not been met. 38 U.S.C.§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for establishing service connection for diabetes mellitus have not been met. 38 U.S.C.§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from October 1966 to October 1969. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, a Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran’s claims file. Service Connection 1. Entitlement to service connection for an acquired psychiatric disorder 2. Entitlement to service connection for diabetes mellitus The Veteran claims service connection for an acquired psychiatric disorder, and diabetes mellitus, to include as related to his service in Vietnam. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed.Cir.1996) (table); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. The evidence confirms that the Veteran served in Vietnam. Accordingly, exposure to herbicides in service is conceded. In March 2014, an endocrine examination was conducted. The examiner indicated there were no documents found in VBMS. The examiner indicated the Veteran had no history of an endocrine condition. In April 2014, a diabetes mellitus opinion was rendered. An examination was not conducted. The reviewing practitioner noted that in July 2013 and October 2013 the Veteran had normal glucose. The examiner noted that diabetes mellitus was not on his VA problem list, and he had not been prescribed any hypoglycemic medicines. At the Board hearing, the Veteran testified that he suffers from diabetes. When questioned as to his claim for service connection for insomnia, he related that he suffers from insomnia as a result of bad dreams of his time in service and has memories he is unable to forget. In February 2020, the Veteran underwent a psychiatric examination. On examination, he described his mood as good. There were no symptoms observed on examination, and the examiner concluded the Veteran does not have a mental health condition. The examiner concluded the claimed psychiatric illness is less likely than not incurred in or caused by an in-service injury, event, or illness. The rationale provided was the Veteran does not have a psychiatric condition. In February 2020, the Veteran underwent a diabetes examination, and after evaluation, the examiner found that the Veteran did not have diabetes. The examiner concluded it is less likely than not that he suffers from diabetes that is related to service. Although the Veteran is competent to describe his symptoms, it is now well established that lay persons without medical training, such as the Veteran, are not competent to opine on matters requiring medical expertise, such as whether he has diagnoses of an acquired psychiatric disorder and diabetes mellitus. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, medical testing and expertise is required to determine the diagnosis of symptoms arising from acquired psychiatric disorder and diabetes mellitus, as well as to determine the etiology of any such condition. The Veteran has not been shown to have medical expertise to render a competent medical opinion as to the diagnosis or etiology of his claimed acquired psychiatric disorder and diabetes mellitus. The medical evidence, which reveals no findings of an acquired psychiatric disorder or diabetes mellitus during the appeal period, is of greater probative value than the Veteran’s contentions. Though he claims to suffer from these conditions, his statements are not competent or credible as VA records show the Veteran’s contacts with health professionals have been numerous, during which time, no diagnosis or treatment for acquired psychiatric disorder and diabetes mellitus, is shown. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See U.S.C §1110. In the absence of proof of a present disability, there can be no valid claim. Brammer, supra; see also Degmetich v. Brown, 104 F.3d 1328 (1997) (38 U.S.C. § 1131 requires existence of present disability for VA compensation purposes). Although there is medical evidence of record dating from over 20 years ago to the present, the preponderance of the competent evidence of records shows no findings of acquired psychiatric disorder and diabetes mellitus, present during the appeal period. In the absence of competent and credible evidence of an acquired psychiatric disorder and diabetes mellitus during the period of the claim, service connection is not warranted on any basis and the claims must be denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). REASONS FOR REMAND 1. Entitlement to service connection for CAD is remanded. In March 2014, the Veteran underwent a heart examination. The Veteran was not diagnosed with a heart condition. The Veteran stated he had no heart problems, but reported high blood pressure and high triglycerides. Blood pressure readings were 149/98, 147/89, 152/89. The examiner remarked the Veteran has pain from gout, and was on cold medication which may have elevated his blood pressure. He has since been prescribed medication to treat his hypertension. In February 2020, the Veteran underwent an examination. A treatment record from October 2018 indicated he used hypertension medication. The examiner stated there are treatment records showing the Veteran has CAD, and treats it with amlodipine. An echocardiogram from February 2020 revealed cardiac hypertrophy and mild decreased global wall motion. Interview based METs test revealed dyspnea, fatigue, and dizziness. The examiner concluded it is less likely than not that the Veteran’s heart disorders, to include hypertension are service connected. The rationale was there are no records showing diagnosis or treatment for a heart disorder while the Veteran was in service. In September 2020, an addendum opinion was rendered. The Veteran reported onset of CAD in 1995; however, the medical records do not support this diagnosis. The examiner then stated there is not enough information to make a determination regarding the onset of CAD. As is stated above, service in Vietnam has been conceded. Though the Veteran underwent an examination, there is not an opinion as to whether the Veteran currently has CAD, and if so, whether it is related to service, to include herbicide exposure. A more thorough opinion as to the etiology of any diagnosed heart disorder is needed. 2. Entitlement to service connection for joint pain, to include chronic demyelinating polyneuropathy, is remanded. The Veteran underwent various joint examinations in February 2020. The examiner provided a positive nexus regarding his right knee’s relation to service, and in a September 2020 decision, the RO granted him service connection for residuals of a right knee strain. The Veteran supplied medical records from June through September 2020 that document his diagnosis and treatment for chronic inflammatory demyelinating polyneuropathy (CIDP). As there is evidence of a condition that causes pain that could be encompassed in his claim for joint pain, a new opinion is needed addressing the etiology of the CIDP. As is stated above, service in Vietnam has been conceded. An opinion is needed to address the etiology of the CIDP. 3. Entitlement to service connection for gout is remanded Treatment records indicate he was seen in June 2013 at the Elmore Community Hospital for gout, osteoarthritis, and a history of elevated triglycerides. In July 2013, the Veteran was seen with complaints of right wrist pain and was diagnosed with gout. At the Board hearing, the Veteran testified that he suffers from gout. The Veteran underwent a gout examination in February 2020. He reported having gout in 1979 and treating it with allopurinol. The last reported incident of gout had been over 12 months prior to the examination date. The examiner opined it is less likely than not that gout is related to service, as there are no records showing diagnosis, treatment for gout or any gout-related disorder while he was in service. Further rationale provided was that the Veteran’s gout had resolved. In a May 2020 problem list from the VAMC, gout is identified. An opinion is needed to address whether the Veteran’s instances of gout during the period on appeal are related to service. 4. Entitlement to service connection for a corneal abrasion is remanded. The Veteran’s STRs contain notes regarding a visit for a corneal abrasion, and indicate he suffered a blow to his face. In December 2013, the Veteran had an optometry examination was assessed as having presbyopia, myopia, astigmatism, cataracts, and blepharitis. At the Board hearing, the Veteran testified that he suffers from eye-related issues. In February 2020, the Veteran underwent an eye examination. The Veteran’s STRs indicate he experienced a blow to the face. In December 2013, he was assessed as having myopia, presbyopia, astigmatism, cataracts, and blepharitis. At the Board hearing he testified to suffering from eye issues. However, presbyopia, myopia, and astigmatism are refractive errors corrected by glasses and are not considered disabilities for service connection purposes. The examiner noted that the Veteran’s cataracts are not clinically significant with visual acuity of 20/20 with correction. The examiner noted that blepharitis can be recurrent, and at the time of the examination was quiescent. The examiner concluded the claimed eye disorder is less likely than not incurred in or caused by an in-service injury, event, or illness. The rationale provided was the Veteran does not have an eye disorder. A new opinion is needed addressing the etiology of his diagnosed cataracts and blepharitis. Service connection is available for any disability present at any time during the appeal period with a nexus to service. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and private medical records and associate these records with the claims folder. The Veteran is asked to submit any and all records in his possession pertaining to his claimed heart disorder. 2. Obtain an addendum opinion for the February 2020 cardiac examination. The need to physically examine the Veteran is left to the discretion of the examiner. The examiner is asked to address the following: (a) Identify each heart condition. (b) Determine whether any of the Veteran’s diagnosed heart conditions fall within the umbrella of ischemic heart disease. (c) Is it at least as likely as not that any diagnosed heart condition, is related to his service (to include CAD, and/or hypertension)? (d) Is it at least as likely as not that any diagnosed heart condition, is related to exposure to herbicide agents, such as Agent Orange? The Veteran is presumed to have been exposed to herbicide agents, to include Agent Orange. In providing the requested opinion, the examiner is reminded that VA laws and regulations do not preclude service connection for a disorder due to herbicide exposure that is not on the list of diseases presumptively associated with exposure to herbicide agents. A complete rationale for all opinions must be provided. 3. Schedule the Veteran for an appropriate VA examination regarding the diagnosed CIDP. The examiner is asked to answer the following: (a) Is it at least as likely as not that the CIDP is related to his service? (b) Is it at least as likely as not that the CIDP is related to exposure to herbicide agents, such as Agent Orange? The Veteran is presumed to have been exposed to herbicide agents, to include Agent Orange. In providing the requested opinion, the examiner is reminded that VA laws and regulations do not preclude service connection for a disorder due to herbicide exposure that is not on the list of diseases presumptively associated with exposure to herbicide agents. A complete rationale for all opinions must be provided. 4. Obtain an addendum opinion for the February 2020 eye examination. The need to physically examine the Veteran is left to the discretion of the examiner. The examiner is asked to address the following: (a) Is it at least as likely as not that any diagnosed eye disability (other than refractive errors) is related to his service? The examiner is asked to specifically address the diagnosed blepharitis and cataracts. The examiner is also asked to provide a rationale for all opinions reached 5. Obtain an addendum opinion for the February 2020 gout examination. The need to physically examine the Veteran is left to the discretion of the examiner. The examiner is asked to address the following: (a) Is it at least as likely as not that gout is related to his service? The examiner is asked to specifically address the treatment records that indicate a diagnosis of gout during the period on appeal. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Skiouris, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.